Premature Babies Are More Likely to Develop This Personality Type

Whether babies are born early can affect the personality traits they develop later, suggests the latest research

How gregarious you are, whether you tend to be anxious all the time and how responsible you are for your own actions certainly depend on a myriad of factors. Genetics, your home and school environment during childhood, as well as early life experiences, all contribute to the type of person you become.

The researchers studied a group of 200 people who were either born when they were less than 32 weeks old or with very low birth weight, both of which have been linked to other health issues in previous studies. These 200 people were compared on personality traits to 197 others born to term and of normal birth weight when all of the people in the study were 26 years old. The group of people born early or of low birth weight were more likely than the controls to fit into what the authors call a socially withdrawn personality; these people scored higher on traits of introversion, neuroticism and autistic features, while scoring lower on risk taking and agreeableness.

All told, premature birth accounted for about 11% of the personality assessment, the researchers say. That’s just a fraction of the different experiences that make up personality, but it’s possible that early birth can set children up for certain traits for a number of different reasons. Biologically, it’s possible that the premature birth exposes infants to a potentially traumatic environment in a neonatal intensive care unit that’s very different from the nurturing, calm experience of babies born to term who are immediately allowed to bond both physically and emotionally with their parents. Second, premature babies may be exposed to certain treatments, including corticosteroids, that can change their metabolic and hormonal development, priming them to be more sensitive to stress and anxiety, for example. And concerned parents of premature infants may tend to be over-protective of their children throughout childhood, contributing to the child’s tendency to avoid risk and worry more.

While personality can’t be traced to one particular experience or event, the scientists suggest that prematurity should be investigated further as a potentially important aspect of personality development. “Defining a general personality profile and understanding its aetiology are important because this higher order personality factor may help to partly explain the social difficulties [prematurely born] individuals experience in adult roles, such as in peer and partner relationships and career,” the authors write.

Planned Parenthood Targeted by Hackers

"We are taking every measure possible to mitigate these criminal efforts"

Planned Parenthood says it has informed the FBI and Department of Justice of a malicious attack on its servers by activist hackers who are threatening to leak the personal data of its staff.

The activists have “called on the world’s most sophisticated hackers to assist them in breaching our systems and threatening the privacy and safety of our staff members,” said Dawn Laguens, executive vice president at PPFA.

The hack, originally reported by the Daily Dot, appears to have been motivated by anti-abortion sentiment. “Trying to mold an atrocious monstrosity into socially acceptable behaviors is repulsive,” one of the supposed hackers told the website. “Obviously what [Planned Parenthood] does is a very ominous practice. It’ll be interesting to see what surfaces when [Planned Parenthood] is stripped naked and exposed to the public.”

Laguens called the hackers “extremists who oppose Planned Parenthood’s mission and services” and said Planned Parenthood was “working with top leaders in this field to manage these attacks.”

The reported breach comes as the organization defends itself against videos from an anti-abortion group that show Planned Parenthood officials negotiating the sale of fetal tissue. Planned Parenthood has said the videos are edited and are part of a “smear campaign.”

Big Soda Sues San Francisco Over Beverage Warnings

Justin Sullivan—2015 Getty ImagesBottles of soda are displayed in a cooler at a convenience store on June 10, 2015 in San Francisco, California.

The soda industry’s largest trade body is suing the city of San Francisco over rules that would require mandatory warning labels on soda advertisements and ban their display on city property.

The lawsuit, filed by the American Beverage Association on Friday, claims the regulations due to come into force July 2016 are unconstitutional. The city, the complaint said, “is trying to ensure that there is no free marketplace of ideas, but instead only a government-imposed, one-sided public ‘dialogue’ on the topic—in violation of the First Amendment.”

The legislation was passed unanimously by the San Francisco Board of Supervisors in June and stands among the strongest laws in the country relating to sugary beverages. The label, which must be affixed to all soda advertisements, would read: “WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes and tooth decay.”

The plaintiffs in the complaint say forcing signs to carry that label “violates core First Amendment principles.”

Other parties to the suit also include the California Retailers Association and the California State Outdoor Advertising Association.

The first nude print ad was published in 1936 for Woodbury Soap. It featured an undressed woman lazily lying at the beach, her arm positioned at just the right angle to shield her breasts from view. It followed the old advertising adage that sex sells.

But that no longer holds true, according to a new study released by the Psychological Bulletin. Brad Bushman, a communications professor at Ohio State University and a co-author of the study, says it’s not that sex and violence don’t grab our attention—of course they do. In fact, paying attention to such things are evolutionary responses that are necessary for survival (being attuned to safety threats prepares people to protect themselves; finding opportunities for mating keep the species going).

But just because they grab our eye doesn’t mean the ad translates into sales.

“[A]dvertisers think sex and violence sell, so they buy advertising time during sexual and violent programs, and in turn producers continue to create sexual and violent programs that attract advertising revenue,” the authors write. But when a person is being shown a product—say, laundry detergent—with a sexy backdrop, it’s not the detergent that’s capturing the attention so much as the action onscreen. Sex is distracting, Bushman says. “We have a limited capacity to pay attention to cues.”

Bushman and his co-author, Robert Lull, found 1,869 articles in two databases that had historically studied consumer response to sex and violence. Researchers weeded out studies that didn’t directly address consumer response, didn’t have a control group, and didn’t look explicitly at the effects of sex and/or violence on the consumer.

“In the best case scenario, sex and violence doesn’t work,” Bushman told TIME. “For advertisers, it can actually backfire, and people will be less likely to remember your [product]. They might report being less likely to buy your product if the content of your program is violent or sexual.”

No surprise, some demographics respond differently to sexy or violent ads. Women tend to remember products from provocative ads; men tend to be distracted by sex or violence and not remember the product. Older participants were turned off by violence and sex; younger consumers were more likely to respond to it.

Still, taken together, the researchers conclude this: “Brands advertised in violent contexts will be remembered less often, evaluated less favorably, and less likely to be purchased than brands advertised in nonviolent media.”

That Makeup Ad Is Probably Lying to You

New study reveals how many ads for cosmetics are inaccurate or false

Only 18% of all claims made in commercials for cosmetics are generally trustworthy, according to new research released Monday.

Cosmetics firms often use advertising verbiage like “clinically proven” or “inspired by groundbreaking DNA research.” But researchers combed through these claims and found that the majority were vague and many are outright lies, according to a new study published in the Journal of Global Fashion Marketing.

The researchers assessed 289 cosmetic ads, including ads for products like make-up, skincare and fragrance, featured in magazines like Vogue and Marie Claire. They then separated the various claims into different categories, including environmental claims, endorsement claims and scientific claims. The researchers rated them as “acceptable,” “vague,” “omission” or “outright lie.”

The study authors conclude that claims of “well-being and happiness” are usually not substantiated. “Those who back the claims with scientific evidence and consumer testing often use questionable methodologies for their substantiation,” the authors wrote.

Shirtless Marines March in ‘Silkies’ to Raise Suicide Awareness

Each day, 22 former servicemembers commit suicide

A group of Marines is marching 22 kilometers, or about 13.5 miles, wearing nothing but short shorts—called “silkies”—and hauling 22 kilograms, or about 50 pounds, of gear to honor the 22 service members who commit suicide every day.

15 Weird Risk Factors for Kidney Stones

Your love for leafy greens may increase risk for kidney stones

Anyone who’s ever passed a kidney stone before has probably wondered how something so small (usually, anyway!) can cause so much pain. Unfair, we know. About 1 in 11 people will suffer from a kidney stone in their lifetime—and once you’ve already had one, you’re about 50% more likely to have another. More bad news: At one time, stones primarily affected men, but new research shows that this gender gap has almost closed, possibly due to the rise in obesity.

What are kidney stones, exactly?

Most kidney stones are a solid mass of minerals that have congealed and lodged itself somewhere in your urinary tract. The majority of them are made of calcium—usually a combination of calcium and oxalate, but, in rarer cases, calcium and phosphate—and, to a much lesser extent, uric acid.

Now for the good news: With a few dietary and lifestyle tweaks, you might be able to slash your odds of ever suffering from a kidney stone again—or, even better, prevent one entirely.

Too little calcium

Since calcium is present in most kidney stones, it makes sense to just cut the nutrient right out of your diet, right? Nope. That was the old thinking. Now experts know that people who consume more calcium are less likely to encounter a kidney stone than those on low-calcium diets, according to one 2013 study by researchers from Harvard Medical School. “It’s all about balance,” says Mantu Gupta, MD, the chair of urology at Mount Sinai Roosevelt and Mount Sinai St. Luke’s Hospital. Dr. Gupta goes on to explain that if your diet is deficient in calcium, chemicals called oxalates, which normally bind to calcium in the digestive tract, will instead bind with calcium in the urine and trigger the formation of stones.

Your salad obsession

You eat all the right things, only to end up in a urologist’s office. What gives? Oxalates, again. These substances are found in leafy greens like spinach, rhubarb, and beets. Ideally, those oxalates will bind with calcium in your intestine and be shuttled out of your body via your urinary tract, says Roger L. Sur, MD, director of the University of California San Diego’s Comprehensive Kidney Stone Center. But when the amount of oxalates is too high, these chemicals can concentrate in the urine and lead to a stone formation. That’s not to say you should give up veggies, of course. Talk to your doctor about possible food swaps for lower-oxalate foods—for example, kale instead of spinach or cauliflower in place of amaranth.

A salty diet

Out of all the potential problems caused by too much salt, kidney stones are probably last on the list. But when your sodium intake rises, that can also trigger an increase in the amount of calcium your kidneys excrete. Translation: A build-up of calcium in the urine, which increases the risk of kidney stone formation, says Brian Stork, MD, a urologist and spokesperson for the American Urological Association. Experts recommend that most people limit their sodium consumption to 2,300 milligrams per day, but other people, like those with high blood pressure, should lower that to less than 1,500 milligrams per day.

Not enough citrus fruits

If you can’t remember the last time you had a lemon or grapefruit, consider this a reason to up your intake: Citrus fruits contain a compound called citrate, which is thought to help lower the risk of some kidney stones, says Dr. Gupta. Plus, one study in the journal Nature found that when people who normally avoided produce added fruits and vegetables into their diet for one month, they decreased the amount of kidney-stone-causing chemicals that were present in their urine. Try adding a lemon or lime wedge to your water daily, says Dr. Gupta.

Too much meat

On the other hand, eating too much poultry and red meat can also put you at risk for stones: One 2014 study in the journal Nutritional Epidemiology found that vegetarians and fish-eaters were 30 to 50% less likely to have kidney stones than people who ate about 100 grams of meat per day (think: a steak and a half). People who load up on meat might be crowding out fruits and vegetables from their diets—a mistake, since produce contains magnesium, which can also prevent stones from forming.

Living in the South

The Southeastern United States might be known as the Bible Belt, but urologists have another name for it: the kidney stone belt. One oft-cited study published in the American Journal of Epidemiology in 1996 found that people living in this area had nearly double the risk of stones as people living in cooler regions of the United States. Blame the hot, arid climate: “Because the temperatures are higher, people in the South can lose more fluid through sweat and become dehydrated,” says Dr. Gupta. When you aren’t drinking enough water, there will be a higher percentage of minerals in a lower amount of urine, increasing the likelihood that those minerals will bind together to form a stone.

Too much iced tea

Another strike against the sweet-tea-loving South. A 2015 report in the New England Journal of Medicine about a 56-year-old man who was rushed to the hospital for kidney failure after drinking too much iced tea shocked the Internet. And as it turned out, black tea (one of the most popular kinds in the U.S.) is also a major source of oxalate, which can cluster in the urine to form kidney stones. This man was drinking about 16 8-ounce glasses of black tea daily, which is at least double the average person’s daily intake. If you’ve had a kidney stone before, ask your doctor about limiting your consumption to one 8-ounce serving a day, says Dr. Gupta, who also notes that people with super high levels may have to cut it out of their diet completely.

A can of soda

Normally, staying hydrated is one of the smartest ways to avoid kidney stones because it dilutes kidney-stone forming substances: (That’s why experts say that drinking about eight glasses of water a day is one way to prevent them from forming in the first place.) But not all beverages are created equal: One 2013 study found that downing even one sugary-sweet soda a day can increase your odds of developing kidney stones by 23%. Researchers think that the fructose (a sugar) in sweetened drinks causes an increase in kidney stone-causing chemicals. Stick to water, minus the sugar.

Your parents

Here’s something else to thank mom and dad for: If either parent has had a kidney stone, your risk increases as well. Sure, families have similar diets, but there’s a biological reason as well. “Like obesity or diabetes, there are multiple genes involved, and oftentimes, people inherit the inability to efficiently absorb oxalate from their parents,” says Dr. Gupta.

Having IBD

People with inflammatory bowel diseases tend to have a higher risk for stones than those without these serious conditions, and one 2013 study in the International Journal of Nephrology and Renovascular Disease found that those with Crohn’s disease and ulcerative colitis were especially at risk. One reason: These conditions are accompanied by diarrhea, which can increase a person’s risk of dehydration—and, in turn, up the percentage of kidney stone-causing chemicals in lower amounts of urine, says Dr. Stork.

Recurring urinary tract infections

In this case, frequent UTIs are a possible sign of a kidney stone. Some background: Not all stones cause pain—in fact, some can pass through your body unnoticed. But other times, kidney stones stay in your urinary tract and block the flow of urine, which could lead to a UTI. This infection is one possible sign that you may have a kidney stone that you don’t know about, explains Dr. Sur. “In some people, the only way we would have found their kidney stones is because they had recurrent urinary tract infections,” he says.

Using too many laxatives

Laxatives have existed for over 2,000 years, and people have been abusing or misusing them that entire time, according to a 2010 study published in the journal Drugs. Older people dealing with constipation who believe they need to have a bowel movement daily for good health comprise a significant number of laxative abusers, but the largest group, by far, is made up of people suffering from anorexia or bulimia. Laxative overuse may interfere with your body’s ability to absorb nutrients and medications, and may also bring on an electrolyte imbalance—and it’s been linked to kidney stones, says Dr. Sur. Using too much of these meds may cause people to become dehydrated, which could trigger a stone.

A migraine medication

People who take topiramate (found in the prescription med called Topamax) can be more likely to have kidney stones than those who don’t take this drug, says Dr. Sur. One 2006 study in the American Journal of Kidney Diseases found that topiramate can increase the pH levels in the urinary tract, which may lead to an increased risk of kidney stone formation. (Talk to your doctor before making any changes to your medication regimen.)

Your weight

Obese women may be about 35% more likely to develop kidney stones than their leaner counterparts, according to a 2011 study in The Journal ofUrology. Researchers aren’t quite sure why, but they suspect that the extra poundage changes the environment in your urinary tract, making it easier for kidney stones to form. “People who are obese have altered urinary pH levels, which can cause a buildup of uric acid-forming kidney stones,” says Dr. Sur.

Weight loss surgery

While it’s true that obesity increases your risk of stones, so can bariatric surgery, according to one 2009 study in The Journal of Urology. “It’s thought that after the procedure, people might not absorb as much calcium from their diets,” says Dr. Stork. “When that happens, the build-up of oxalate in the urinary tract could lead to a kidney stone.” If you’ve recently had surgery, talk to your doctor about how you can cut your risk, either by drinking more water, limiting meat and sodium, or consuming enough calcium.

6 Things Every Woman Should Know About Yeast Infections

So-called 'preventative' products may cause more harm than good

Sorry to be a downer, but if you haven’t had a yeast infection yet, you’ll probably get one eventually. Three out of four women will experience one sometime in her life—and half will have two or more. “These are so common because yeast normally lives on your skin and around your vagina,” says Melissa Goist, MD, an ob-gyn at The Ohio State University Wexner Medical Center. When something disrupts the vagina’s natural balance of healthy bacteria, yeast (aka the fungus Candida) can grow out of control. And then comes the telltale down-there itching and burning sensation that can drive you up a wall.

Whether you’ve been visited by a yeast problem once, a bunch of times, or not yet, you may be surprised by the truth about these frustrating infections. Here are the facts every woman should know.

The symptoms can mimic other problems

One study found that as few as 11% of women who have never had a yeast infection could identify the symptoms, while other research has found that only one-third of women who thought they had a yeast infection actually did. Why the confusion?

The signs are similar to other down-there problems. If you have a yeast infection, you might notice burning, itching, pain during sex, and a thick white odorless discharge.

But if it smells fishy, it may instead be bacterial vaginosis (BV), and if you have only burning and pain during urination, that suggests a urinary tract infection. Bottom line: It can be difficult to figure out.

First-timer? Go to the doctor if you think you have one

Now you know the signs, but remember: Just because you can buy over-the-counter treatment for a yeast infection doesn’t mean you always should. The first time you experience symptoms, it’s important to see your doctor (or hit up an urgent care center if you can’t score an appointment) because if it turns out you don’t have a yeast infection, at-home treatments can make inflammation worse or not provide any relief at all, Dr. Goist says.

A doctor will be able to correctly pinpoint the problem (yeast infection or something else) then give you personalized treatment, like an Rx for the oral antifungal fluconazole as well as a topical skin cream to reduce inflammation.

After that, you’ll know exactly what to watch out for, and your doc may give you the all clear to self-treat your next one with an over-the-counter antifungal, like Monistat or generic clotrimazole.

You don’t need products to prevent them

Gynecologists like to call the vagina a “self-cleaning oven.” That’s because it doesn’t need any help with douches, scented gels, perfumes, and other “feminine” products to stay clean. In fact, rather than helping prevent a yeast infection, these can cause an imbalance of the healthy bacteria in your vagina that makes you more susceptible to a yeast infection, explains Dr. Goist.

What to do if it happens after sex

A yeast infection is not technically a sexually transmitted infection (STI), but sex can throw off the bacterial balance in your vagina, upping your risk for a yeast overgrowth. That said, if you get what you think is a yeast infection after sex with a new partner, it’s a good idea to see your doctor, so you can rule out any potential new STIs, as well.

The truth about wet bathing suits

You’ve probably heard hanging out in wet clothes is a recipe for disaster. Doctors often say it’s a good idea to change out of a wet suit or sweaty exercise clothes because yeast thrives in warm, wet environments. And that’s true. But it’s mostly important for women who suffer from recurrent episodes rather than the general population. “Unless you know you’re prone to yeast infections, you won’t necessarily get one by hanging out in a wet suit,” Dr. Goist says. Make changing a priority if you get them frequently, otherwise, you’re probably fine.

Switching birth control pills may make you more susceptible

Anything that alters your hormone levels—like changing to a new hormonal birth control pill (that increases your estrogen levels) or too much stress (high cortisol) is a risk factor. Other things to watch out for: taking antibiotics, which kill healthy bacteria in the vagina, allowing yeast to thrive; or having uncontrolled blood sugar levels if you have type 2 diabetes (high blood sugar can feed yeast). If any of these sound like you and you get yeast infections, come up with a plan with your doc about how to control them.

Seattle Flunks Vaccine Science

In the same week Nigeria frees itself from polio, vaccine rates continue to fall in the Pacific northwest

Nothing says First World city like Seattle does. Come for the cachet, stay for the Seahawks, and give a nod to the Starbucks and the Amazon and the mothership that is Microsoft just to the east. There’s nothing this so-hip-it-hurts town lacks, it seems—except perhaps for common sense. If you’re looking for that, the developing world is a far better bet.

That’s the inescapable conclusion on what should be a very good week for public health—and childhood health in particular—with the World Health Organization and other groups announcing on July 24 that Nigeria has gone a full year without a single reported case of polio. Pending further certification, the country will be removed from the dwindling list of countries in which the disease is endemic, leaving just Pakistan and Afghanistan. If Nigeria’s caseload remains at zero for two more years, it will be officially declared polio free.

How did the country that as recently as 1988 saw 30,000 children—a stadium’s worth—paralyzed or killed by polio every year achieve such a stunning turnaround? No surprise: vaccines—the same vaccines that have saved the lives and health of millions of children around the world, and the same vaccines that saw polio eradicated entirely in the U.S. in 1979.

So it came as a head-slapping development that earlier this month, Seattle news outlets reported that polio vaccination rates in their city have hit a low of just 81.4%, or worse than the rates in Rwanda, Zimbabwe, Algeria, El Salvador, Guyana, Sudan, Iran, Kyrgyzstan, Mongolia and Yemen, according to the WHO. Why? Because Rwanda, Zimbabwe, Algeria, El Salvador, Guyana, Sudan, Iran, Kyrgyzstan, Mongolia and Yemen may have a lot of problems, but they don’t have the anti-vaccine crazies.

Vaccine denialism is a perverse affliction of people who should be smarter than they act—the well-educated, high-income folks who know just enough to know too much, and to assume that simply because they haven’t seen a disease in a long time it’s gone away. And hey, if it does turn up, they’ve surely got the resources to deal with it.

That’s the reason that in the U.S., anti-vaxxers tend to cluster in wealthy, blue-state communities like Silicon Valley, New York City, Columbus, Seattle and it’s down-coast little sister Portland. It’s the reason too that the nonsense that animates the anti-vaxxers—the idea that vaccines are toxic or overprescribed or nothing more than a cash grab by big pharma and big government—is a lot likelier to gain traction in other wealthy countries around the world than in ones that have only recently done away with scourges like polio or are still struggling with them, and either way have images of sick or dying children still fresh in their minds.

“Polio is nonexistent in the states, so if you’re going to travel, it makes sense to do it,” said one Washington State resident interviewed by Seattle’s KUOW radio station on July 14. “We are doing vaccines based on our family’s needs, not based on what doctors say we need to follow.”

Never mind how abjectly ridiculous that thinking sounds if you shift its frame even a little: “We are fire-proofing our home based on our family’s needs, not based on what the fire department say we need to follow,” or “We are fastening our seat belts during turbulence based on our family’s needs, not based on what flight attendants say we need to follow.”

Never mind, too, that that the very reason polio is non-existent in the states is because people have been good about getting vaccinated and that, as an outbreak in an unvaccinated Amish community in 2003 showed, there is no virus in the world that isn’t just an incoming airline flight away. If it lands in a community where vaccine rates are low, it will find plenty of people to infect.

What’s more, while polio may indeed have been KO’ed in the states years ago, measles, mumps, rubella, whooping cough and more are all very much still at large, and outbreaks of those diseases have been on the rise thanks to the anti-vaxxers. The vaccination rate for measles, mumps and rubella specifically is below 90% among Seattle kindergarteners, dangerously short of the 95% rate needed to keep communities as a whole protected.

For most people, living in the developed world is a mere accident of birth and geography—a demographic freebie that gets you started in life far ahead of people born in less lucky places. Privilege can be part of that first world birthright, as can wealth and freedom and the opportunity for good heath. But smarts, it seems, have to be earned. That, clearly, is something Nigeria and Rwanda could teach Seattle.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

This New FDA-Approved Cholesterol Drug Is a Game Changer

The FDA approved the first of a new class of drugs for treating high cholesterol. Here’s the story of how researchers went from a DNA mutation to a drug in 10 years

On Friday, the U.S. Food and Drug Administration (FDA) approved the first new class of cholesterol-lowering drugs since the statins flooded the market beginning in the 1980s. Similar to the way statins work, by binding up cholesterol made in the liver so less of it circulates in the blood, this new class, called PCSK-9 inhibitors, takes advantage of genetic mutations that regulate the level of LDL receptors in the liver. Less PCSK9 leads to more LDL receptors that can soak up LDL and therefore leave less cholesterol in the blood.

The FDA approved alirocumab (Praluent), an injectable drug made by Sanofi and Regeneron, in people with familial hypercholesterolemia, a genetic condition in which cholesterol levels are high, or those with a history of heart disease who can’t reduce their LDL levels enough with existing statin drugs. (Another PCSK9 inhibitor, evolocumab (Repatha) developed by Amgen, received approval in Europe but won’t be evaluated by the U.S. FDA until the end of August.)

While PCSK9 drugs help to lower cholesterol, the story of how these medications developed began in a French family with the opposite problem. Their members had exceptionally high levels of LDL and greater than average rates of heart disease. But unlike others with similar cholesterol problems, this family did not have the usual mutations in cholesterol-regulating genes. Instead, French researchers studying them in 2003 found they had aberrations in PCSK9, a gene that produces a protein found primarily in the liver, kidneys and intestines.

An ocean and half a continent away, Jonathan Cohen and Dr. Helen Hobbs at the University of Texas, Southwestern Medical Center in Dallas (coincidentally the same institute where scientists discovered LDL, or the heart-disease contributing cholesterol and earned the Nobel Prize for their work), read the description of PSCK9 and wondered whether those with lower levels of PCSK9 would show the opposite effect of the French family and actually enjoy decreases in levels of LDL in the blood.

Cohen and Hobbs were involved in a large heart disease study involving nearly 15,000 participants, and decided to look for the PCSK9 mutations among their participants. They homed in on those with the highest and lowest levels of LDL cholesterol, and sequenced their genomes to see if any patterns emerged. Sure enough, they found 33 people whose LDL levels were about 40% lower than average and who shared mutations that effectively silenced PCSK9. Essentially, their LDL amounts were about the same as those who relied on statins to drop their cholesterol.

These PCSK9 mutations associated with the lowest LDL appeared predominantly in African-American participants. Those with one copy of the mutation in this gene showed an 88% lower risk of heart disease. Another mutation in the same PCSK9 gene that appeared more commonly in whites had the same effect, but to a lesser extent, dropping LDL by 15% and the risk of heart events by 47%.

To confirm this, Cohen searched for anyone in the study with two copies of the mutation, to see if having double the effect would trigger any adverse events. He found one woman, a 32 year old daughter of one of the participants, who had two different mutations in each of the PCSK9 copies she inherited from her mother and father. The result? An LDL of 14 and no other health problems. “If you measure the amount of PCSK9 in her blood, it’s basically absent, you can’t see any,” says Cohen. That contributed to an unprecedented low level of LDL cholesterol as well.

So far, he says, only one other individual has been described with two mutant copies of PCSK9, a 21 year old woman living in south Africa with an LDL of 20.

Those descriptions piqued the interest of researchers at Regeneron, a biotech company that specializes in turning genetic discoveries like this one into drugs. To confirm and better understand the effects of PCSK9, researchers there studied the effect of human versions of PCSK9 in mice, and then began trials of antibodies they developed that inhibit the function of this gene, much like the mutations do, in several thousand people.

Those results, published in the NEJM last April, showed that PCSK9 inhibitors can lower LDL cholesterol by an additional 60% on average beyond that achieved by statins. Those findings formed the basis of the companies’ application to the FDA for approval of these first-in-class drugs.

For now, the agency says the drugs should only be prescribed to people with familial hypercholesterolemia, or those who have failed to reduce their LDL levels sufficiently using statins. For many, the new drugs will be taken in combination with statins and a heart-healthy diet. But doctors say they anticipate many patients outside of these groups, who have family histories of heart disease or other risk factors, such as hypertension or diabetes, may start asking about the medications. For them, doctors will have to weigh how well they are doing on statins before considering adding a PCSK9 inhibitor.